Neighborhood Effects on Missed Appointments in a Large Urban Academic Multispecialty Practice

Area of Science:

• Health Services Research
• Social Determinants of Health
• Health Equity

Background:

• Missed medical appointments negatively impact healthcare continuity and quality.
• Understanding factors contributing to missed appointments is essential for improving patient outcomes.

Purpose of the Study:

• To investigate the association between patient residential neighborhood characteristics and the likelihood of missing scheduled appointments.
• To identify specific population descriptors linked to appointment no-shows.

Main Methods:

• Retrospective cross-sectional study utilizing electronic health records and census tract data.
• Analysis of 275,682 appointments for 58,981 adult patients from 2014-2015.
• Multinomial generalized linear mixed models were employed to assess associations, controlling for patient-level factors.

Main Results:

• Overall, 17.5% of scheduled appointments were missed.
• Higher rates of missed appointments were associated with census tracts exhibiting higher violent crime (aOR=1.27), greater proportion of Hispanic (aOR=1.27) and Black (aOR=1.13) populations, higher poverty levels (aOR=1.19), and lower perceived neighborhood safety (aOR=1.06).

Conclusions:

• Neighborhood socioeconomic and safety characteristics are significantly associated with missed healthcare appointments.
• Interventions targeting social determinants of health in underserved communities are vital to enhance healthcare access and reduce appointment no-shows.